Direct anterior bone block grafting for treatment of bone defects and dysplasia of the coronoid process

Abstract

The aim of the surgery was to treat an elbow instability caused by critical coronoid bone loss (CCBL), lateral ulnar collateral ligament (LUCL) insufficiency,and general hyperlaxity by performing adirect anterior coronoid bone graft (CBG) and LUCL reconstruction in the same setting. In cases with CCBL isolated ligament reconstruction harbors ahigh failure rate, necessitating supplementary bony procedures. The diagnosis of CCBL is confirmed through lateral radiographs and further quantified through computed tomography (CT) imaging. Objective assessment of instability is conducted with standardized arthroscopic tests. Performing an anterior approach for CBG offers distinct advantages, notably in terms of achieving precise positioning of plates and screws and providing access to the proximal radioulnar joint. Usual contraindications to surgery, coronoid bone loss less than 40%. The surgical procedure is thoroughly illustrated with avideo of the operation that can be accessed online: reconstruction of the LUCL with asemitendinosus allograft, harvesting of the graft from the iliac crest, exposure of the coronoid process with adirect anterior approach, freshening up of the graft bed. Temporary fixation of the graft with aKirschner wire. Assessment of joint congruency, stability and range of motion (ROM) prior to definitive fixation with a2.4 mm buttress plate and screws. Nonsteroidal anti-inflammatory drugs (NSAID) to prevent heterotopic ossification. Elbow mobilization in pronation from day1 with an overhead motion protocol. Removable splint for 4weeks, free mobilization at 6weeks, return to sport at 3months. Durable elbow stability was achieved along with free ROM and high patient satisfaction.